Autologous bone flap salvage strategies in postcraniotomy surgical site infections: A scoping review

Background: This scoping review sought to examine the available evidence on bone flap preservation techniques following postcraniotomy surgical site infection (SSI) when simultaneously reimplanted at the time of debridement. Methods: A broad search of PubMed and Embase databases was conducted using relevant search terms. Records were filtered, screened, and assessed for eligibility for further analysis by two reviewers. Data, including study characteristics, demographic and intervention details, and success rates, were extracted. Results: Initial broad searches yielded 1,513 records. Of these, 8 studies, including 2 case reports, 1 prospective, and 5 retrospective case series, were selected for inclusion. The pooled sample consisted of 92 patients, both adults and children, with a mean age of 44.4 years, of whom 55.4% were male. The average reported time to follow-up was 21.4 months. All studies reported patient intervention that included surgical debridement, antibiotic therapy, and intraoperative bone flap sterilization. A novel “wash in, wash out” technique involving postoperative in situ antibiotic irrigation was used in 3 studies. The overall pooled success rate for autologous bone flap salvage was 94.5%. Conclusion: Bone flap preservation at the time of wound debridement combined with antibiotic therapy in postcraniotomy SSI demonstrates high success rates. However, evidence is limited and low quality. Consensus guidelines are needed but will require comparative prospective trials to determine optimal treatment mechanisms, duration and choice of antibiotics, longer-term outcomes, and cost-benefit differences.